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Microbiologic Identification of Bleb-related Delayed-onset Endophthalmitis Caused by Moraxella Species

Cornut, Pierre-Loïc MD*; Chiquet, Christophe MD, PhD; Bron, Alain MD; Romanet, Jean-Paul MD; Lina, Gérard MD, PhD§; Lafontaine, Pierre-Olivier MD; Benito, Yvonne PhD§; Pechinot, André MD; Burillon, Carole MD*; Vandenesch, François MD, PhD§; Denis, Philippe MD, PhD*for the FRIENDS Group

doi: 10.1097/IJG.0b013e31816299ec
Original Studies
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Purpose To report the clinical presentation and outcome of delayed-onset endophthalmitis caused by Moraxella species and to evaluate the eubacterial polymerase chain reaction (PCR) in aqueous humor samples for the microbiologic diagnosis.

Patients and Methods Seven patients with bleb-related delayed onset-endophthalmitis caused by Moraxella were included in a prospective multicenter study (FRIENDS group, 2004 to 2005). Eubacterial PCR followed by direct sequencing and conventional cultures were carried out on aqueous humor samples taken before the first intravitreal antibiotic injection and on vitreous samples taken during pars plana vitrectomy.

Results All cases were postoperative (5 after filtering surgery and 2 inadvertent filtering blebs). The mean delay of onset of endophthalmitis was 41.3 months±30.4 (SD) (range, 2.4 to 84.8) after surgery. Initial visual acuity was limited to light perception for 3 patients, hand motions for 2 patients, count fingers for 1 patient, and 20/125 for 1 patient. Functional recovery was variable with final visual acuity ranging from no light perception to 20/25. The eubacterial PCR carried out on aqueous humor provided microbiologic identification in all cases, whereas the cultures were negative in 6 of 7 cases. The eubacterial PCR performed on vitreous samples of 3 vitrectomized patients, after 2 intravitreal injections of antibiotics, identified Moraxella in 2 patients, whereas cultures were negative in all cases.

Conclusions Delayed-onset endophthalmitis caused by Moraxella occurs predominantly after a bleb-related infection. PCR is a more sensitive technique for the microbiologic diagnosis in this context than conventional culture.

*Department of Ophthalmology, University Hospital, Claude Bernard University, Hôpital Edouard Herriot, Lyon

Department of Ophthalmology, University Hospital, Joseph Fourier University, Grenoble

Departments of Ophthalmology

Microbiology, University Hospital, Dijon University, Dijon

§Department of Microbiology, University Hospital, Claude Bernard University, Hôpital Louis Pradel, Bron, France

Sources of support: Supported by grants from Hospices Civils de Lyon, Alcon Laboratories, Sanofi-Aventis Laboratories.

Conflict of Interest: None.

Ethical Adherence: This study followed the Declaration of Helsinki guidelines for research involving human individuals and was approved by the Institutional Review Board (Comité de Protection des Personnes, CPP Lyon B).

FRIENDS group: French Institutional Endophthalmitis Study Group (Lyon, Dijon, Saint-Etienne, Grenoble, France).

A list of all participants of the FRIENDS group is mentioned before reference.

Reprints: Christophe Chiquet, MD, PhD, Department of Ophthalmology, Chu de Grenoble, 38043 Grenoble cedex 09, France (e-mail: cchiquet@chu-grenoble.fr).

Received for publication August 9, 2007; accepted November 18, 2007

© 2008 Lippincott Williams & Wilkins, Inc.